Swine flu update : Mortality

Mortality from flu

Seasonal influenza results in higher mortality rates among patients with certain chronic medical conditions, as well as in pregnant women and those at the extremes of age. A similar pattern is observed with pandemic H1N1 influenza A, although few elderly individuals have been affected.

As of July 27, 2009, there have been 134,503 laboratory-confirmed cases of pandemic H1N1 influenza A worldwide, including 816 deaths (0.6%)

In Mexico, 119 of 10,262 laboratory-confirmed cases (1.2 percent) have been fatal. Most of these deaths were related to respiratory failure resulting from severe pneumonia with multifocal infiltrates and acute respiratory distress syndrome.

In addition to respiratory failure, renal or multi-organ failure occurred in 24 percent of cases in Mexico.

As of July 24, 2009, among 43,771 cases reported in the United States, there have been 302 deaths (0.7 percent). In Argentina, 60 of 2485 cases (2.4 percent) have been fatal.

Of 45 fatal cases in Mexico, 24 (54 percent) occurred in previously healthy individuals, most of whom were between the ages of 20 and 59. Most of the deaths outside Mexico have occurred in individuals with underlying health problems.

Patient do not need N95 mask

Only health care workers need N 95 mask, as it is inspiratory mask and filter air before it is inhaled. For patients we need simple three layered surgical masks, which can prevent infectious material expectorated out from contaminating the environment. N95 mask means a tightly fitted mask with a capacity to filter out 95% of the organisms of 1-micron size at a flow rate of 50 L/minute and with less than 10% leakage.

Stop reporting routine flu case

CDC stopped reporting of individual confirmed and probable cases of novel H1N1 infection on July 24, 2009. Now CDC reports only total number of hospitalizations and deaths on a weekly basis.

As per the US figures only 2-5% of the flu patients required admissions. As on 7th August out of 6506 patients admitted 436 died with a mortality of 6.7%.

Imagining the worst situation in Delhi, 100% people getting affected by swine flu, with a population of 1.38 crores, 2.76 lac people affected with flu may require admissions. Delhi has a total bed capacity of 41629 only as on 31st March 2008 with eighty percent beds in the private sector. In terms of mortality it may translate to a total of 19320 deaths over time (once hundred percent of Delhi population is affected). But as per "WHO" only 33% are expected to get swine flu in the next two years which translates to 17% this year. The first year swine flu deaths in Delhi will translate to 3284 deaths.

As per "economic survey" 100974 people died in Delhi in 2008. Out of them heart diseases (including diabetes) caused 19362 deaths, TB 2516, cancer 2597, pneumonia 879, accidents 1088, anemia deaths, measles 52, burns 824, meningitis 476, cholera 54 and others 72474 deaths.

Every year over 5 lac people die of human flu all over the world. In the US alone flu and pneumonia is responsible for 6% of all deaths. In Delhi with annual deaths of 100974 it (human flu) will translate to 6058 deaths every year.

Deaths can be reduced

Adapting to a correct heart friendly lifestyle can reduce heart disease deaths. Postponing getting flu infection till an effective vaccine is available can reduce swine flu deaths. One can postpone getting swine flu infection by adapting to respiratory flu hygiene measures incorporating 3 feet distance precautions, frequent hand hygiene, and learning cough etiquettes. One must also remember that not all are at risk of flu deaths. The ones at risk are people with co-morbid conditions like heart patients not including high blood pressure; uncontrolled diabetes; chronic patients with liver, kidney or lung diseases; cancer and the elderly.

From AMA

Cabinet secretaries detail new guidelines for flu-related school closings: need not be closed

NBC Nightly News (8/7, story 8, 2:30, Williams) reported that on Friday, the federal government "had some guidance for parents and communities worried about the expected resurgence of swine flu just as schools open for the fall term. They're urging precautions, but of course no panic." NBC's Bazell added, "Most schools should try to stay open this fall and winter, even if they have cases of swine flu. That message [Friday] from top federal officials, who also say they expect some outbreaks could get so bad that some schools will have to close. But the decision should always be made by local authorities."

ABC World News (8/7, story 6, 2:05, Gibson) reported that "the government guidelines were issued as US trials begin on a vaccine." ABC's Stark added, "In Seattle late [Friday], the first US trial of an H1N1 swine flu vaccine got underway. Seven other vaccine centers start their trials next week. A vaccine isn't expected until at least mid-October."

The AP (8/7, Quaid) noted, "The government is urging school officials to stay calm when swine flu strikes this fall, closing buildings only in drastic cases and allowing sick students to return as soon as 24 hours after their fever is gone. ... Closing schools is rarely warranted, even if students or teachers have swine flu," Frieden said.

The Washington Post (8/8, Hsu) added, "Top Obama health, education and homeland security officials said that new evidence about the global pandemic shows that the disruption caused by mass closures outweighs any potential benefits of closures, at least for now." The New York Times (8/8, A11, Grady) reported that the "secretaries of education, homeland security and health and human services described the guidelines for schools with grades kindergarten through 12 on Friday at a news briefing in Washington, along with the director of the Centers for Disease Control and Prevention. Guidelines for colleges and employers are set to be issued on Aug. 23."

According to the Wall Street Journal (8/8, A5, Prada, McKay), "Now that the virus is better understood, and perceived as less of a threat, the guidelines remain cautious but seek to avoid widespread closures. Instead of shutting down, schools should isolate students and staff who appear to have the flu, keeping them in a separate room until they can be sent home, the CDC said. Those who are ill and those caring for them should wear surgical masks to prevent transmission, the agency said."

The Chicago Tribune (8/8, Glanton) reports, "Saying the hardships related to school closures outweighed the benefits, the federal government today issued new guidelines encouraging schools to remain open this fall when there are only small numbers of students diagnosed with swine flu." TheWashington Times (8/8, Geracimos) reports, "Affected people are advised to stay home at least 24 hours after they no longer have a fever of 100 degrees or greater, under the new guidelines that officials said are meant to help decrease the spread of flu among students and school staff during the 2009-10 school year. A previous recommendation said people should stay home for one week and schools should stay closed for about two weeks if swine flu, or the H1N1 virus, was suspected."

The San Francisco Chronicle (8/8, Allday) reports, "The revised guidelines suggest that schools close only if illness is so widespread that it becomes difficult to hold classes, or if a single case is found at a school where a large number of students have underlying health risks, such as schools for disabled children or pregnant teenagers."

CQ HealthBeat (8/8, Norman) reported, "School districts might want

to start setting up school-based clinics at which mass vaccinations for the H1N1 influenza virus would be administered to students once the vaccine is available this fall, federal government officials said Friday." Education Secretary Arne Duncan said that officials have found "a tremendous outpouring of support" for the idea, adding that the setting was "a natural location" for the vaccination effort. 

Regards

Dr KK Aggarwal